Importance: Synthetic cannabinoids (SCs), commonly known as K2, spice, or fake weed, are cheap, artificially manufactured recreational drugs that have emerged as a major public health threat in various regions of the US.
Objective: To describe the clinical manifestations of SC intoxication.
Design, Setting, And Participants: This case series assessed adults admitted to the intensive care unit from 2014 to 2016 with acute life-threatening complications of SC use.
Objectives. We conducted a study to answer 3 questions: (1) is CT pulmonary angiography (CTPA) overutilized in suspected pulmonary embolism (PE)? (2) What alternative diagnoses are provided by CTPA? (3) Can CTPA be used to evaluate right ventricular dilatation (RVD)? Methods. We retrospectively reviewed the clinical information of 231 consecutive emergency department patients who underwent CTPA for suspected PE over a one-year period.
View Article and Find Full Text PDFChylothorax is a recognized complication of intrathoracic surgery, but its occurrence after coronary artery bypass grafting (CABG) is very rare. We report a case of a fatal pulmonary embolism as a complication of chylothorax following CABG. The patient was an 82-year-old woman who presented with increasing chest pain 2 weeks after discharge after an uncomplicated CABG.
View Article and Find Full Text PDFThe number of cases of out-of-hospital cardiac arrest is estimated to be 300,000/year in the United States. Two landmark studies published in 2002 demonstrated that therapeutic hypothermia decreased mortality and improved neurological outcome after out-of-hospital cardiac arrest. Our institutional pathway for the management of survivors of cardiac arrest stresses teamwork involving multiple disciplines, including cardiology, critical care, nursing, neurology, infectious diseases, physical therapy, social work, and pastoral care.
View Article and Find Full Text PDFCrit Pathw Cardiol
June 2011
The management of patients after cardiac arrest is a prominent example of complexity on many levels of decisions. We designed a pathway for the management of survivors of cardiac arrest, guiding such decisions as cardiac catheterization, induction of therapeutic hypothermia, placement of defibrillator, and ethical decision making for life support. Our pathway outlines the comprehensive management of patients from the field through the emergency room, the cardiac catheterization laboratory, the cardiac care unit, step down unit, and the rehabilitation center.
View Article and Find Full Text PDFStatus asthmaticus requiring mechanical ventilation is an uncommon, life-threatening disorder in obstetric patients. The unique physiologic changes of pregnancy, impact of the fetus on the maternal condition, and concerns for fetal and maternal health and survival are particular concerns in critical illness. Furthermore, the issues of hypoxemia and hypercapnia, ventilator management and complications make this disease of respiratory failure an especially important area for review.
View Article and Find Full Text PDFSouth Med J
January 2007
Women with sickle cell anemia are surviving longer and may desire pregnancy. Rare, life-threatening complications of sickle cell anemia, such as acute chest syndrome, may occur at the time of delivery. A 22-year-old woman with sickle cell (HbS/beta+ thalassemia) at 35 weeks of gestation presented with shortness of breath and generalized pain.
View Article and Find Full Text PDFThe obstetric patient poses exceptional challenges in the intensive care unit. Knowledge of the physiologic changes of pregnancy and specific pregnancy-related disorders is necessary for optimal management. Intensive care unit diagnoses may include preeclampsia, including the HELLP syndrome, pulmonary embolic disease, amniotic fluid embolism, status asthmaticus, respiratory infection, the acute respiratory distress syndrome, and sepsis.
View Article and Find Full Text PDFSerum troponin I (TnI) is a sensitive marker of cardiac injury. A relation between elevated TnI and mortality has been suggested. In this retrospective chart review of 221 patients admitted to the medical intensive care unit (MICU) during a 6-month period, the authors studied the use of admission TnI levels in predicting mortality in MICU-admitted patients.
View Article and Find Full Text PDFJ Intensive Care Med
February 2005
A 49-year-old man with Ehlers-Danlos syndrome developed acute respiratory failure requiring mechanical ventilation. Chest computed tomography demonstrated giant right bulla extending into the contralateral hemithorax with mediastinal shift. Surgical bullectomy with pleurodesis relieved tension effects and allowed weaning.
View Article and Find Full Text PDFJ Intensive Care Med
February 2005
A 70-year-old woman was admitted to the intensive care unit with refractory nonconvulsive status epilepticus. Extensive evaluation including neuroimaging and cerebrospinal fluid examination was unrevealing. Brain biopsy revealed spongiosis, and prion disease was confirmed by immunostaining, providing the diagnosis of Creutzfeldt-Jakob disease.
View Article and Find Full Text PDFNecrotizing pleuropulmonary infection in a patient with acquired immunodeficiency syndrome developed due to Corynebacterium afermentans subspecies lipophilum. Long-term combination antibiotic therapy was successful in eradicating the infection without surgery.
View Article and Find Full Text PDFJ Intensive Care Med
April 2004
A 45-year-old woman with HIV infection presented with thrombotic microangiopathy 1 week after initiating therapy with the nucleoside analogue abacavir. She was successfully treated with plasmapheresis and corticosteroids.
View Article and Find Full Text PDFStatus asthmaticus is a life-threatening episode of asthma that is refractory to usual therapy. Recent studies report an increase in the severity and mortality associated with asthma. In the airways, inflammatory cell infiltration and activation and cytokine generation produce airway injury and edema, bronchoconstriction and mucus plugging.
View Article and Find Full Text PDFPulmonary sequestration is a rare congenital or acquired pulmonary anomaly. Pulmonary sequestration may be classified as intralobar, located within normal lung, or extralobar, in which it is separated by pleura. The coexistence of both forms is extremely rare.
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